Integumentary System Diseases and Disorders Chapter 18 Integumentary System Diseases and Disorders

Anatomy and Physiology Skin Largest organ of body First line of protection for body against invading organisms Provides sense of touch, heat, cold, and pain

Anatomy and Physiology Skin Helps stabilize temperature, fluid, and electrolyte balance Three layers: Epidermis Dermis Subcutaneous

Animation Click Here to Play Skin Animation

Common Signs and Symptoms Skin lesions Pain Pruritus Edema Erythema Inflammation

Diagnostic Tests Biopsy Culture and sensitivity Blood tests Microscopic smear examinations

Infectious Diseases: Viral Herpes Large family of viruses Symptoms: Inflammation of skin Clusters or fluid-filled vesicles Periods of remission and exacerbation No cure Remains in affected individual’s body for life

Infectious Diseases: Viral Herpes Common types: Herpes simplex 1 Fever blisters Cold sores Herpes simplex 2/Herpes genitalis Genital herpes

Infectious Diseases: Viral Herpes Common types: Herpes varicella Chickenpox Herpes zoster Shingles

Herpes Simplex Virus 1 Photo courtesy Robert A. Silverman, MD, Pediatric Dermatology, Georgetown University

Infectious Diseases: Viral Verrucae Also known as warts Chronic condition Occur in multiples and differ in size, shape, and appearance Often resistant to treatment

Infectious Diseases: Viral Verrucae Common types: Appearance on hands and fingers of children Appearance on sole of foot Plantar warts Sexually transmitted Genital warts

Verrucae Photo courtesy Mark L. Kuss

Infectious Diseases: Bacterial Impetigo Streptococcus and staphylococcus Affects face and hands of children Symptoms: Vesicles Pustules that rupture Producing yellow crust over lesions

Infectious Diseases: Bacterial Impetigo Treatment: Cleansing Antibiotic ointment

Infectious Diseases: Bacterial Folliculitis Inflammation and infection of hair follicle Common cause: Staphylococcus Symptoms: Small pustules surrounding hair Treatment: Antibiotics

Folliculitis Photo courtesy Robert A. Silverman, MD, Pediatric Dermatology, Georgetown University

Infectious Diseases: Bacterial Abscess, furuncle, and carbuncle Inflammation, infection, and formation of capsule prevent spread of infection Treatment: Antibiotics

Infectious Diseases: Bacterial Cellulitis Diffuse or spreading inflammation of skin and subcutaneous tissue Causes: Streptococcus Staphylococcus Treatment: Antibiotics

Infectious Diseases: Bacterial Cellulitis Prevention: Good handwashing Cleansing of open areas on skin

Infectious Diseases: Bacterial Erysipelas Acute infection of dermis extending to fat tissue Causes: Most commonly Group A streptococcus Treatment: Oral or IV antibiotics

Infectious Diseases: Bacterial Lyme disease Multisystem infections transmitted to humans through bite of infected deer tick Symptoms: Flu-like symptoms Arthritis Malaise

Infectious Diseases: Bacterial Lyme disease Symptoms: Chills Fever Bull’s eye skin rash Symptomatic treatment: Antibiotics

Infectious Diseases: Bacterial Methicillin-resistant staphylococcus aureus (MRSA) Both hospital- and community-acquired Diagnosed by culture and drug sensitivity testing Resistant to antibiotics commonly used Treatment: Vancomycin

Infectious Diseases: Fungal Tinea Also known as ringworm Infects warm, moist areas of body Feeds on perspiration and dead skin Symptoms: Itching, cracking, and weeping of skin

Infectious Diseases: Fungal Tinea Treatment: Keep affected area clean and dry Use antifungal agents

Infectious Diseases: Fungal Tinea Types: Tinea corporis Affects smooth skin on arms, legs, and body Tinea pedis Athlete’s foot Tinea cruris Jock itch

Infectious Diseases: Fungal Tinea Types: Tinea unguium Affects fingernails or toenails Tinea capitis Affects scalp Tinea barbae Affects bearded areas

Tinea Pedis Photo courtesy Centers for Disease Control and Prevention

Tinea Unguium Photo courtesy Mark L. Kuss

Infectious Diseases: Fungal Candidiasis Fungal infection Cause: Candida Symptoms: Red, itchy skin with blisters and pustules Treatment: Antifungal medications

Infectious Diseases: Parasitic Pediculosis Infestation with lice Treatment: Bathing and shampooing with medicated shampoo E.g., Kwell

Infectious Diseases: Parasitic Pediculosis Types: Head Body Pubic

Infectious Diseases: Parasitic Scabies Caused by tiny mite Also known as seven-year itch Symptoms: Slightly elevated, grayish-white lines Intense itching Vesicles Pustules

Infectious Diseases: Parasitic Scabies Treatment: Lindane cream to entire body

Scabies Photo courtesy Robert A. Silverman, MD, Pediatric Dermatology, Georgetown University

Metabolic Diseases Acne vulgaris Inflammation of sebaceous glands and hair follicles Symptoms: Comedones

Metabolic Diseases Acne vulgaris Treatment: Cleansing Over-the-counter (OTC) treatments In severe cases, antibiotics, steroids, and Retin-A preparations

Metabolic Diseases Seborrheic dermatitis Affects sebaceous glands Also known as cradle cap in infants Also known as dandruff when affecting scalp

Metabolic Diseases Seborrheic dermatitis Symptoms: Treatment: Reddened, itchy areas Scales Treatment: Wash and dry Steroid creams

Seborrheic Dermatitis Photo courtesy Centers for Disease Control and Prevention

Metabolic Diseases Sebaceous cyst Sebaceous gland becomes blocked and sebum collects under skin Special type: Pilonidal cyst Treatment: Incising and draining Surgical removal

Hypersensitivity or Immune Diseases Eczema Inflammation of skin Symptoms: Itching Redness Vesicles Pustules

Hypersensitivity or Immune Diseases Eczema Symptoms: Scales Crusting Treatment: Topical cortisone Antihistamines Sedatives

Eczema Photo courtesy Centers for Disease Control and Prevention

Hypersensitivity or Immune Diseases Urticaria Also known as hives or nettle rash Vascular reaction of skin Causes: Irritants Treatment: Antihistamines Avoidance of allergen

Hypersensitivity or Immune Diseases Contact dermatitis Acute or chronic allergic reaction of skin Causes: Cosmetics Laundry products Jewelry

Hypersensitivity or Immune Diseases Contact dermatitis Symptoms: Pain Small red localized lesions to vesicular lesions

Hypersensitivity or Immune Diseases Scleroderma Hardening, thickening, and shrinking of connective tissues Including skin Autoimmune reaction

Idiopathic Diseases Psoriasis Chronic skin disease Symptoms: Red, raised lesions with distinct borders and silvery scales Treatment: Coal tar medications Ultraviolet light Steroids

Psoriasis Photo courtesy Robert A. Silverman, MD, Pediatric Dermatology, Georgetown University

Idiopathic Diseases Rosacea Chronic skin condition Symptoms: Redness of forehead, nose, cheeks, and chin Treatment: Avoid triggers E.g., sun exposure No cure

Benign Tumors Seborrheic keratosis Benign overgrowth of epithelial cells Symptoms: Tan or brown growths Warty scale appearance Treatment: Curettage Scraping off

Benign Tumors Keloid Raised, firm, irregular-shaped scar tissue following trauma or surgery Treatment: Surgical removal

Benign Tumors Hemangioma Congenital benign tumor of small blood vessels that form purplish birthmark Common types: Port wine stain Strawberry hemangioma Cherry hemangioma

Premalignant and Malignant Tumors Actinic keratosis Premalignant condition Common in fair-skinned individuals Symptoms: Wart-like lesions on sun-exposed areas

Premalignant and Malignant Tumors Actinic keratosis Treatment: Topical medication E.g., Retin-A Curettage Cryotherapy

Premalignant and Malignant Tumors Basal cell carcinoma Most common type of skin cancer Slow-growing, locally invading tumor that does not metastasize Treatment: Surgical removal

Basal Cell Carcinoma Photo courtesy Mark L. Kuss

Premalignant and Malignant Tumors Squamous cell carcinoma Tends to occur in sun-exposed areas Symptoms: Firm red nodule with crusts or slightly elevated plaque Treatment: Wide surgical excision Radiation

Squamous Cell Carcinoma Photo courtesy Robert A. Silverman, MD, Pediatric Dermatology, Georgetown University

Premalignant and Malignant Tumors Malignant melanoma Most serious type of skin cancer Symptoms: Change in size and color of mole Rarely occurs before age 20 May be related to severe sunburn as child

Malignant Melanoma Photo courtesy Mark L. Kuss

Premalignant and Malignant Tumors Malignant melanoma Treatment depends on degree of spread: Wide surgical excision Radiation Chemotherapy

Premalignant and Malignant Tumors Kaposi’s sarcoma Malignant vascular skin tumor Bluish-red cutaneous nodules Treatment: Treat AIDS Liquid nitrogen Radiation Chemotherapy

Abnormal Pigmented Lesions Types: Ephelis Freckle Lentigo Liver spot Nevus Mole

Abnormal Pigmented Lesions Types: Albinism Decrease or total absence of pigment in skin, hair, and eyes Melasma Dark patches of skin on face Especially cheeks

Abnormal Pigmented Lesions Types: Vitiligo Destruction of melanocytes in small or large patches of skin

Diseases of the Nails Abnormal shape, thickness, and color Causes: Most commonly fungal and bacterial infections Treatment: Bacterial infections treated with antibiotics Fungal infections treated with antifungal medications

Diseases of the Hair Hirsutism Alopecia Excessive growth of hair Partial or complete hair loss

Mechanical Skin Injury Abrasion Scraping away skin surface Blunt trauma Contusion by item E.g., hammer, club Thrown into item E.g., steering wheel, wall

Mechanical Skin Injury Avulsion Skin or appendage pulled or torn Crush trauma Tissue caught between two hard surfaces

Mechanical Skin Injury Puncture injury Sharp object forced into tissue Laceration Cut in skin caused by sharp object

Thermal Skin Injury Hyperthermia Body overheated due to excessive exposure to sun or heat Types: Heat exhaustion Heat stroke

Thermal Skin Injury Burns First degree: Second degree: Third degree: Pain, redness, and swelling Second degree: Pain, redness, swelling, blisters, and open wounds Third degree: Charred and broken skin tissue Painless

Thermal Skin Injury Cold injuries Not as severe or life-threatening as heat or burn injuries Low body temperature

Thermal Skin Injury Cold injuries Symptoms: Extreme shivering Mental confusion Blue or cyanotic extremities Weak pulse

Thermal Skin Injury Cold injuries Treatment: Frostbite Remove wet clothing Warm body with warm blankets Drink warm liquids Frostbite Freezing of tissue Usually on face, fingers, toes, and ears

Electrical Injury Causes: Damage has point of entry and exit Unprotected or inadequately insulated electrical wiring Contact with lightning Damage has point of entry and exit

Radiation Injury Ionizing radiation Causes: E.g., x-rays Exposure to sunlight Tanning beds Damage to skin

Pressure Injury Decubitus ulcer Also known as bedsore or pressure sore Affects bony areas of body E.g., heels, sacrum, elbows Treatment: Frequent turning and repositioning Massaging of affected area to improve circulation

Pressure Injury Corns and calluses Protective hyperplasias of tissue Often painful Most common on feet from ill-fitting shoe Can be surgically removed

Pressure Injury Corns and calluses Calluses Not usually painful Most common on hands

Insect/Spider Bites May cause swelling and itching at site Venom or poison may cause allergic reaction Range from mild to severe Requires calling 911 for immediate assistance

Insect Bites/Stings May be from mosquitoes, flies, fleas, wasps, hornets, yellow jackets, and ants Symptoms: Swelling Itching

Insect Bites/Stings Usually mild reaction that disappears in hours or one day Sever allergic reaction may require immediate intervention

Spider Bites Black widow Brown recluse spider Most common poisonous spider Brown recluse spider Very dangerous

Spider Bites Treatment: Ice Analgesics Prompt medical care

Rare Diseases Elephantiasis Hypertrophy of skin and subcutaneous tissue Inflammation of lymphatic system results in fluid accumulation Causes: Parasitic worm

Effects of Aging Thinning of epidermal layer Xerosis Retains less water Xerosis Decreased function of sweat and sebaceous glands Loss of elasticity

Effects of Aging Thickening of nails Thickening and increased brittleness of hair Loss and graying of hair Skin lesions